Hemiplegia

Overview same side arm and leg muscle paralysis called hemiplegia. Below is sometimes associated with ipsilateral muscles and muscle paralysis. Cause pathogenesis of cerebral cortex from the campaign started by the internal capsule. brainstem to the anterior horn cells of the neural pathway between any lesion may have hemiplegia, the onset implicit attacks was slow development of hemiplegia, more cause for intracranial space-occupying lesions, such as brain tumors, brain abscess, intracranial hematoma, brain parasite, such as the performance characteristics of the spinal cord hemiplegia etiology for most of the spinal cord tumors, spinal tuberculosis, spinal lesions, rheumatoid hypertrophic epidural. Sudden onset and rapid development of the multi-hemiplegia caused by cerebrovascular disease. The main clinical manifestations of the lower limbs on the side of movement disorders. In four clinical manifestations : ① consciousness hemiplegia : performance for the sudden disturbance of consciousness, and was accompanied hemiplegia, The first and often the eyes side deflection. ② flaccid hemiplegia : performance on the side of the lower limb movement disorder accompanied by arbitrary obvious, hypotonia involuntary muscle paralysis obviously face involuntary muscle paralysis may not emerge, such as gastrointestinal motility, bladder muscle, and other obstacles did not happen. ③ spastic hemiplegia : general by the flaccid transitional from hemiplegia, which was characterized by significantly increased muscular tension. The upper limbs and lower limbs extensors of the flexor group obviously paralysis, muscular tension increased significantly, the performance of the upper extremity buckling, leg extension, fingers were buckling state, passive stretch out the hand stiff resistance flu. ④ light hemiplegia : hemiplegic very minor cases, such as for the early hemiplegia, or a sexual attack, the onset hemiplegia gap period, a slight paralysis, if not carefully examined easily missed. Differential diagnosis (1) cortex and subcortical hemiplegia cortex hemiplegia, upper limb paralysis obviously, as a remote. If cortical stimulation phenomenon seizures. Parietal lobe lesions, a cortical sensory dysfunction, characterized by shallow feeling that sense, the normal temperature pain and entities McGREGOR, location quotient, Tinel obvious obstacles. Distal sensory obstacles to clear. Right cortex hemiplegia often associated with aphasia, apraxia, agnosia, and other symptoms (right) -, Bilateral hemiplegia associated with subcortical consciousness disorder, mental symptoms. Hemiplegia cerebral cortex no general muscular atrophy, late have disuse atrophy; However, the parietal lobe tumors can be caused by hemiplegia obviously muscular atrophy. Cortical or subcortical hemiplegia tendon hyperreflexia, but other pyramidal tract levy not obvious. Cortical and subcortical hemiplegia in the middle cerebral artery disease and the most common, followed by trauma, tumor, occlusive disease. syphilitic or heart disease caused by cerebral embolism. (2) Cystic hemiplegia pyramidal tract, by the Department of capsule after injury with cystic hemiplegia, hemiplegia performance within the cystic lesions of the contralateral including that the lower facial muscles, the muscle of the upper and lower limbs paralyzed. Hemiplegia at the bilateral cortical disclaimer by the muscles are not involved, the masticatory muscles, the eyes and throat muscles, trunk and upper facial muscles. But sometimes the upper facial muscles can suffer mild, sometimes in the amount of muscle weak performance eyebrows slightly lower than the contralateral, can also be orbicularis oculi muscle weak, but those obstacles are temporary and will soon return to normal. Hindlimb internal capsule of the former 2 / 3 damage, increased muscle tone early on and obviously, extend to the pathological muscle reflex is prone to occur. forelimb internal capsule damage appeared rigidity, pathological reflex flexor in the main group. Cystic hemiplegia within the most common cause of the middle cerebral artery branch in the lenticulostriate artery occlusion or hemorrhage. (3) brainstem hemiplegia (also known as cross-hemiplegia) brainstem lesions caused by the performance of hemiplegia more cross-hemiplegia, that is the side of cranial nerve palsy and contralateral limbs paralyzed. In the etiology of vascular inflammation and tumors were seen. 1. Brain hemiplegia : (1) Weber syndrome : is the cerebral cross-hemiplegia, the typical representation Its characteristics are lateral oculomotor nerve palsy, hemiplegia contralateral lesions. As the oculomotor nerve palsy, it appeared on the clinical face sag, Mydriasis, eye in the place outside under strabismus. Normal eye sometimes seen together palsy, that is Foville's syndrome, may hemiplegia is accompanied by side with the feeling numb, and ataxia. The mechanism of the Weber syndrome on the basis of more extensive lesions, affect the eye and brain stem preoptic hub approach. And sensory fibers and cerebellum-beam induced. (2) Benedikt's symptoms : The performance of contralateral lesions incomplete hemiplegia, Meanwhile hemiplegic side dance and Athetosis hyperactivity. 2. Pons hemiplegia : (1) Millard - Gubler's syndrome : ipsilateral lesion and surrounding facial paralysis ipsilateral abducens nerve palsy, hemiplegia contralateral lesions, was cross-paralysis. Because of the facial nerve nucleus in the pons high fiber cross terminated in the lower part of the pontine nuclear facial nerve, by Xu issuing come forward nerve fibers to the dorsal medial bypass outreach nucleus, and then to VMH. pons and the medulla oblongata at the junction of the brain. Face-to-face on nuclear nerve fibers cross the pontine lesions, lesions that reappearance ipsilateral peripheral facial paralysis, and outreach nerve palsy, Cone contralateral limbs on the cross-beam damage paralysis. (2) Foville's syndrome : performance for facial paralysis. abducens nerve palsy while two lesions to the contralateral attention. in fact Millard - Gubler's syndrome with two preoptic dyskinesia. it should be said Millard - Gubler - Foville's syndrome. If ipsilateral lesion invading Cong trigeminal nerve root or spinal trigeminal approved a facial lesion ipsilateral insensitive. 3. Medullary hemiplegia : (1) medullary upper Syndrome : A Case of lower limb paralysis on the opposite side, lesion ipsilateral muscle paralysis and muscle atrophy. (2) adjacent to the center of the medullary syndrome; Contralateral lesions with deep feeling and fine sensory dysfunction. (3) medullary dorsal lateral syndrome (wallenberg's syndrome) : sometimes accompanied by light hemiplegia. Additionally, there are ipsilateral limb ataxia, nystagmus, the ipsilateral soft palate to sag, vocal cord paralysis, facial nuclear sensory dysfunction, Horner's disease. (4) Babinski - Nageotte's syndrome : hemiplegia and in the contralateral unilateral separation sensory dysfunction, vascular disorder. Ipsilateral lesion facial sensory dysfunction, cerebellar ataxia syndrome, Horner's sign, nystagmus, the soft palate, pharyngeal and laryngeal muscle paralysis (Avellis syndrome). (5) cross-medullary lesions : the crossover precancerous lesions can contralateral limbs paralyzed. (4) a spinal hemiplegia. Cone cross the following : hemineglect spinal cord lesion, the lesion in the ipsilateral upper leg paralysis without cranial nerve palsy, deep lesions side sensory dysfunction, a temperature of the contralateral, pain barrier (Brown-S'equard syndrome). 2. Cervical enlargement (cervical thoracic 5 ~ 2) damage : there will be hemiplegia. Performance of the upper extremity motor yuan paralysis of lower limbs on motor neuron paralysis. Sensory loss, urinary incontinence and to diffuse the arm neuralgia. Horner's often levy.